Please include a signature with the details of his diagnosis - it's very hard to answer your questions otherwise.

If you're saying they noticed an extracapsular extension (ECE) on an MRI, that means the cancer from the prostate gland is growing into the surrounding tissue. Depending on its size and location, that might preclude surgery, or make it more difficult for the surgeon to get it all without cutting into neurovascular bundles or other important structures. Have you investigated radiation?

Yes, it is still local (stage T3a). You only need a second opinion on the MRI if you don't have an experienced radiologist. You can fill out a nomogram (below) to see the odds that surgery can cure it (progression free probability):

Not really. Extracapsular extension means it is growing through the capsule ("extra" means outside of) that surrounds the prostate except at the apex where it becomes indistinct. As it breaks through the prostate capsule, it eats into the tissues in the prostate bed that surround it. Those tissues may include the neurovascular bundles, periprostatic fat, and various layers of tissue called fascia. Once it is out of the prostate, it can shed and spread cancer cells more easily. That's why it is a good idea to start with radiation for T3 because it treats a "safety" margin outside of the prostate where those invisible cancer cells may be nesting.

Yeah, so what you know Smara, is that with ECE the prostate cancer has grown at least into the walls of the so-called "capsule." It may or may not have spread beyond.

There is some interesting work being done on potentially adding some "grading" to the ECE classification. Right now, there is no grading...it's just the presence or absence of ECE.

But a 4-level system of grading has been proposed which is more detailed and helpful in forecasting prognosis. The first 3 levels have identifiable features & characteristics which are distinguishable, but from an outcomes perspective all are more like those cases in which cancer cells have not extended into structures beyond the capsule, and the prognosis is quite good for absence of recurrence. The 4th grade group encompasses scenarios in which the prognosis for progression is not so good. Obviously, agreement on the proposed grading needs to take place, but this represents finer discrimination of ECE cases which will or will not progress.

Envision that with the highest grade level, adjuvant radiation therapy is clearly recommended; with lower grades there is greater pause because the benefits vs. risks/costs are not so great as many cases do not otherwise progress.

What NKinney wrote has nothing to do with your situation. He is talking about post-prostatectomy diagnosis.

Margin abutting the capsule means that the edge of a tumor is up against the edge of the prostate capsule.

Would you please enter your diagnostic info in a signature. To do that, go to My profile> Edit profile> Signature and enter the details of his diagnosis: Gleason score, PSA, stage, age, MRI results and any other details you think are relevant. Then hit "submit." The next time you post anything, check the box that says "include signature." If you can't understand how to do this, please email me.Allen - not an MD •PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement•SBRT 9 yr onc. results •SBRT 7 yr QOL results•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog

Tall Allen said...Not really. Extracapsular extension means it is growing through the capsule ("extra" means outside of) that surrounds the prostate except at the apex where it becomes indistinct. As it breaks through the prostate capsule, it eats into the tissues in the prostate bed that surround it. Those tissues may include the neurovascular bundles, periprostatic fat, and various layers of tissue called fascia. Once it is out of the prostate, it can shed and spread cancer cells more easily. That's why it is a good idea to start with radiation for T3 because it treats a "safety" margin outside of the prostate where those invisible cancer cells may be nesting.

What may be confusing you is the clinical staging T4, which means that it has invaded such structures as the external sphincter, rectum, bladder, levator muscles, and/or pelvic wall.

So how much "margin" do most RO's use to treat the ECE that is possible?

Sounds like 3-4 mm is he distance the tumors can grow outside??

I found this:

https://www.ncbi.nlm.nih.gov/pubmed/10699615

Extent of extracapsular extension in localized prostate cancer.

Sohayda C1, Kupelian PA, Levin HS, Klein EA.

Author information

Abstract

OBJECTIVES:

To measure the radial extent of extracapsular penetration by tumor cells, thereby providing estimates of the margins needed around target volumes. New radiotherapeutic techniques, like brachytherapy and conformal radiotherapy, irradiate small volumes and reduce the dose to periprostatic tissues. Even in the early stages of localized prostate cancer, extracapsular extension (ECE) is commonly seen.

METHODS:

Two hundred sixty-five consecutive radical prostatectomy specimens were analyzed for the presence of ECE. ECE was found in 92 of all cases (35%); measurements were performed in 79 of the 92 cases. A total of 98 ECE sites were evaluated in the 79 cases. The distance of tumor outside the capsule was measured in millimeters. Extension less than 0.1 mm was considered as "focal".

RESULTS:

The site of ECE was posterolateral in 53% of cases, lateral in 24%, posterior in 13%, and at the base in 10%. The median amount of ECE at all sites was 1. 1 mm (mean 1.7). However, the range was wide; the minimum measurable extent was 0.1 mm and the maximum 10.0 mm. The extent was within 3.8 mm for 90% of all cases. By stratifying cases with favorable and unfavorable tumors, the 90th percentiles of ECE were as follows: 3.3 mm for favorable tumors (clinical Stage T1-2, initial prostate-specific antigen 10 ng/mL or less, and biopsy Gleason score 6 or less) and 3.9 mm for unfavorable tumors (clinical Stage T3, initial prostate-specific antigen greater than 10 ng/mL, or biopsy Gleason score 7 or greater).

CONCLUSIONS:

Most of the ECE was at posterolateral sites. The extent of disease outside the prostate was within 4 mm in 90% of cases. Since ECE was observed in 30% to 60% of all patients with clinical Stage T1-2 prostate cancer, only 3% to 7% of all such cases would have disease extent exceeding 4 mm. The present study provides useful estimates of the amount of ECE. These estimates could be potentially used in planning the target volumes for treatment of prostate cancer with either conformal radiotherapy or brachytherapy

There is no distinct capsule that surrounds the prostate, however historically the “capsule” has been defined as an outer band of the prostatic fibromuscular stroma blending with endopelvic fascia that may be visible on imaging as a distinct thin layer of tissue surrounding or partially surrounding the peripheral zone.

"Margin abutting the capsule" means that the tumor touches this layer but have not penetrated the "capsule". Then it is ok to say that it is still "inside the capsule", I would believe in a non-medical vocabulary.

After the surgery you will know for sure if it has penetrated the capsule or not. This shouldn't be a problem for an experienced and competent surgeon.

S'maraI agree with Gemlin that abutting does not mean ECE. However, the MRI may have noticed a bulge that would constitute ECE. If your doctor told you there is ECE, he probably saw something. You should be asking the doctors these questions. You aren't supplying enough info for any of us to answer your questions.